Questionnaire Name:______________________________________________________________________________
Address:_____________________________________________________________________________ ____________________________________________________________________________________ Zip______________________ Country __________________ Home Phone:________________________ Work Phone:___________________________________ Number of children:________ Ages:____________________________________________________ Referred:_____________________________________________________________________________ Residence: Single Family_____ Apt/Condo_____ Trailer_____ Farm_____ Other________________ Are you willing to permit a home check? Yes____No____ Fenced yard? Yes____No____ Leashed walks? Frequent_____Occasional_____None_____ How many hours left alone per day?_____________________________________________________ Where will dog stay when alone?________________________________________________________ ____________________________________________________________________________________ When family is home?__________________________________________________________________ Do you currently own a dog?________ How many?______ Breed, sex, name and age of dog(s)_______________________________________________________ _____________________________________________________________________________________ Do you have a preference about male or female dog?_________________________________________ Do you have a color preference?__________________________________________________________ Ears: uncropped__________ Does anyone in your family have allergies to dogs __________________________________________ On a scale from 1 to 10 ( 10 being the most active) how active would you say your family is _______ Would puppy be with you during this family activity? Yes____ No_____ Are you willing to travel to pick up dog? Yes_____No_____ Are you aware of the yearly costs of maintaining a healthy dog?______________________________ Why do you want a dog?_______________________________________________________________ ____________________________________________________________________________________ What aspect of a dog is most important to you? Protection__________Friendship_______________ How would you prevent, manage your dog’s inappropriate (not so good) Behavior?____________________________________________________________________________ ____________________________________________________________________________________ Are all members of your household aware you are acquiring a dog?_____________________________ Do they all approve?_______ Who will be primary caregiver?___________________________________________________________ Disposition of prior dog(s): stolen_____ran away_____sold_____given away______died_____euthanized______ Why?________________________________________________________________________________ _____________________________________________________________________________________ Veterinarian (name & number)___________________________________________________________ Vet checks are made so please inform your vet that a breeder will be calling him for Information Thank you, Phyllis Copy and Paste this Questionnaire to send by email to willowrun@toast.net . To send by mail please use the PRINTABLE QUESTIONNAIRE 
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